| 1. |
- Aarnio, Pauliina, et al.
(författare)
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Male involvement in antenatal HIV counseling and testing : exploring men's perceptions in rural Malawi
- 2009
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Ingår i: AIDS Care. - : Informa UK Limited. - 0954-0121 .- 1360-0451. ; 21:12, s. 1537-1546
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Tidskriftsartikel (refereegranskat)abstract
- Antenatal care can act as an excellent tool to improve access to HIV counseling and testing services. This paper investigates an issue that may weaken its potential, namely lack of male involvement. We explored married men's perceptions of HIV in pregnancy and male involvement in antenatal HIV testing and counseling in Southern Malawi through 11 focus group discussions and a cross-sectional survey (n=388). The main findings were that men were largely unaware of available antenatal HIV testing and counseling services, and perceived it overall problematic to attend female-oriented health care. Most men supported provision of antenatal HIV testing. They perceived husbands to participate in the process indirectly through spousal communication, being faithful during pregnancy, and supporting the wife if found HIV-positive. Involvement of husbands was compromised by men's reluctance to learn their HIV status and the threat that HIV poses on marriage. Men stressed the importance of prior spousal agreement of antenatal HIV testing and considered HIV testing without their consent a valid reason for divorce. We suggest that male involvement in antenatal HIV testing requires refocusing of information and health services to include men. To avoid negative social outcomes for women, comprehensive and early involvement of men is essential.
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| 2. |
- Abel-Ollo, K., et al.
(författare)
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Knowledge of HIV serostatus and risk behaviour among injecting drug users in Estonia
- 2009
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Ingår i: AIDS Care. - : Informa UK Limited. - 0954-0121 .- 1360-0451. ; 21:7, s. 851-857
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Tidskriftsartikel (refereegranskat)abstract
- We used the findings from two, cross-sectional studies of HIV serostatus and risk behaviours to assess the effects of knowledge of HIV serostatus and risk behaviours (relating to sex and injection drug use) among injecting drug users (IDUs). Respondent-driven sampling was used simultaneously at two sites in Estonia (the capital Tallinn, and the second-largest city of Ida-Virumaa County, Kohtla-Järve). The research tool was an interviewer-administered survey. Biological samples were collected for HIV testing. Participants were categorised into three groups based on HIV testing results and self-report on HIV serostatus: HIV-negative (n=133); HIV-positive unaware of their serostatus (n=75); and HIV-positive aware of their serostatus (n=168). In total, 65% of the participants tested positive for HIV. Of those 69% were aware of their positive serostatus. HIV-positive IDUs aware of their serostatus exhibited more risk behaviours than their HIV-positive counterparts unaware of their serostatus or HIV-negative IDUs. Effective prevention of HIV among IDUs should therefore, include programmes to reduce high-risk sexual and drug use behaviours at the public health scale and enhanced prevention efforts focusing on HIV-infected individuals.
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| 3. |
- Abraha, Atakelti, et al.
(författare)
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The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system : a case-control study
- 2019
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Ingår i: AIDS Care. - : Routledge. - 0954-0121 .- 1360-0451. ; 31:10, s. 1271-1281
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Tidskriftsartikel (refereegranskat)abstract
- Services that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.
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| 4. |
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| 5. |
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| 6. |
- Biru, Mulatu, et al.
(författare)
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Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia
- 2017
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Ingår i: AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV. - : Informa UK Limited. - 0954-0121. ; 29:4, s. 436-440
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Tidskriftsartikel (refereegranskat)abstract
- To achieve optimal virologic suppression for children undergoing antiretroviral therapy (ART), adherence must be excellent. This is defined as taking more than 95% of their prescribed doses. To our knowledge, no study in Ethiopia has evaluated the level of treatment adherence at the beginning of the child's treatment. Our aim was therefore to evaluate caregiver-reported ART non-adherence among children and any predictors for this during the early course of treatment. We conducted a prospective cohort study of 306 children with HIV in eight health facilities in Ethiopia who were registered at ART clinics between 20 December 2014 and 20 April 2015. The adherence rate reported by caregivers during the first week and after a month of treatment initiation was 92.8% and 93.8%, respectively. Our findings highlight important predictors of non-adherence. Children whose caregivers were not undergoing HIV treatment and care themselves were less likely to be non-adherent during the first week of treatment (aOR = 0.17, 95% CI: 0.04, 0.71) and the children whose caregivers did not use a medication reminder after one month of treatment initiation (aOR = 5.21, 95% CI: 2.23, 12.16) were more likely to miss the prescribed dose. Moreover, after one month of the treatment initiation, those receiving protease inhibitor (LPV/r) or ABC-based treatment regimens were more likely to be non-adherent (aOR = 12.32, 95% CI: 3.25, 46.67). To promote treatment adherence during ART initiation in children, particular emphasis needs to be placed on a baseline treatment regimen and ways to issue reminders about the child's medication to both the health care system and caregivers. Further, large scale studies using a combination of adherence measuring methods upon treatment initiation are needed to better define the magnitude and predictors of ART non-adherence in resource-limited settings.
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| 7. |
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| 8. |
- Carlsson-Lalloo, Ewa, et al.
(författare)
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People living with HIV in Sweden report high levels of sexual satisfaction in a registry-based cohort study
- 2021
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Ingår i: AIDS Care. - : Routledge. - 0954-0121 .- 1360-0451.
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Tidskriftsartikel (refereegranskat)abstract
- Sexual satisfaction can be challenging for people living with HIV (PLWH). To investigate self-reported sexual satisfaction in PLWH and its association with HIV-related biomarkers, a retrospective observational cohort study with data on sociodemographic characteristics and changes in PLWH’s assessment of their sexual satisfaction over time were retrieved from the Swedish National Quality Assurance Registry (InfCareHIV) where patient-related outcomes are reported annually. PLWH who had assessed self-reported sexual satisfaction 2011–2016 were included. Sexual satisfaction was dichotomized into sexual “satisfaction and dissatisfaction” and associations were analysed. In total, 3798 patients (66% men) answered 8202 questionnaires. Overall, 67% reported sexual satisfaction, with women more satisfied than men (72% vs 64%, p < 0.0001). Sexual satisfaction did not differ between patients on antiretroviral treatment (ART) >6 months whether the viral load was suppressed or not. Overall, the probability of reporting sexual satisfaction increased by 4% annually (p < 0.001). This increase may be explained by evolving knowledge about the minimal risks of sexual HIV transmission when on ART together with Sweden’s concomitant revision of legal restrictions. The use of patient-related outcomes in clinical practice is an important tool for facilitating conversations about sexuality in order to promote the health and well-being of PLWH. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 9. |
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| 10. |
- Dahl, Viktor, et al.
(författare)
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Acceptance of HIV testing among women attending antenatal care in south-western Uganda: risk factors and reasons for test refusal.
- 2008
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Ingår i: AIDS Care. - : Informa UK Limited. - 0954-0121 .- 1360-0451. ; 20:6, s. 746-752
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Tidskriftsartikel (refereegranskat)abstract
- A problem commonly encountered in programs for prevention of mother-to-child-transmission (PMTCT) of HIV in sub-Saharan Africa is low rates of HIV test acceptance among pregnant women. In this study, we examined risk factors and reasons for HIV test refusal among 432 women attending three antenatal care clinics offering PMTCT in urban and semi-urban parts of the Mbarara district, Uganda. Structured interviews were performed following pre-test counselling. Three-hundred-eighty women were included in the study, 323 (85%) of whom accepted HIV testing. In multivariate analysis, testing site (Site A: OR = 1.0; Site B: OR = 3.08; 95%CI: 1.12-8.46; Site C: OR = 5.93; 95%CI: 2.94-11.98), age between 30 and 34 years (<20 years: OR = 1.0; 20-24 years: OR = 1.81; 95%CI: 0.58-5.67; 25-29 years: OR = 2.15; 95%CI: 0.66-6.97; 30-34 years: OR = 3.88; 95%CI: 1.21-13.41), mistrust in reliability of the HIV test (OR = 20.60; 95%CI: 3.24-131.0) and not having been tested for HIV previously (OR = 2.15; 95%CI: 1.02-4.54) were associated with test refusal. Testing sites operating for longer durations had higher rates of acceptance. The most common reasons claimed for test refusal were: lack of access to antiretroviral therapy (ART) for HIV-infected women (88%; n=57), a need to discuss with partner before decision (82%; n=57) and fear of partner's reaction (54%; n=57). Comparison with previous periods showed that the acceptance rate increased with the duration of the program. Our study identified risk factors for HIV test refusal among pregnant women in Uganda and common reasons for not accepting testing. These findings may suggest modifications and improvements in the performance of HIV testing in this and similar populations.
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| 11. |
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| 12. |
- Evangeli, M, et al.
(författare)
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ERRATUM
- 2009
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Ingår i: AIDS care. - : Informa UK Limited. - 1360-0451 .- 0954-0121. ; 21:4, s. 539-539
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Tidskriftsartikel (refereegranskat)
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| 13. |
- Evans, D., et al.
(författare)
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Social and behavioral factors associated with failing second-line ART - results from a cohort study at the Themba Lethu Clinic, Johannesburg, South Africa
- 2018
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Ingår i: Aids Care-Psychological and Socio-Medical Aspects of Aids/Hiv. - : Informa UK Limited. - 0954-0121. ; 30:7, s. 863-870
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Tidskriftsartikel (refereegranskat)abstract
- Poor adherence is a main challenge to successful second-line ART in South Africa. Studies have shown that patients can re-suppress their viral load following intensive adherence counselling. We identify factors associated with failure to re-suppress on second-line ART.The study was a retrospective cohort study which included HIV-positive adults who experienced an elevated viral load 400copies/ml on second-line ART between January 2013-July 2014, had completed an adherence counselling questionnaire and had a repeat viral load result recorded within 6 months of intensive adherence counselling. Log-binomial regression was used to evaluate the association between patient characteristics and social, behavioral or occupational factors and failure to suppress viral load (400copies/ml).A total of 128 patients were included in the analysis, and of these 39% (n=50) failed to re-suppress their viral load. Compared to those who suppressed, far more patients who failed to suppress reported living with family (44.2% vs. 23.7%), missing a dose in the past week (53.3% vs. 30.0%), using traditional/herbal medications (63.2% vs. 34.3%) or had symptoms suggestive of depression (57.7% vs. 34.3%).These patient-related factors could be targeted for interventions to reduce the risk for treatment failure and prevent switching to expensive third-line ART.
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| 14. |
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| 15. |
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| 16. |
- George, Gavin, et al.
(författare)
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Greater risk for more money: the economics of negotiating condom use amongst sex workers in South Africa
- 2019
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Ingår i: AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV. - : Informa UK Limited. - 0954-0121 .- 1360-0451. ; 31:9, s. 1168-1171
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Tidskriftsartikel (refereegranskat)abstract
- © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. The economics of sex work and the effect on safe sex practices remain understudied. This research contributes to a better understanding of how economic opportunity and vulnerability place sex workers (SWs) at an increased risk of STI infection. Using quantitative and qualitative methods, we investigated the role of economic incentives in determining condom use among SWs. The data reveals that SWs are on average, nearly doubling their rates for condomless sex. Our findings that SWs are engaging in condomless sex to increase their earnings, illustrates the point that the context in which they operate influences condom negotiation and consequently, increases risky sexual behaviour.
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| 17. |
- George-Svahn, Lisa, et al.
(författare)
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Barriers to HIV testing as reported by individuals newly diagnosed with HIV infection in Sweden
- 2021
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Ingår i: AIDS Care. - : Taylor & Francis. - 0954-0121 .- 1360-0451. ; 33:10, s. 1286-1295
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Tidskriftsartikel (refereegranskat)abstract
- Despite the availability of free and anonymous HIV testing almost 60% of Swedish patients are diagnosed late. Identifying predictors of different types of barriers could inform policy makers and health care of interventions to increase testing where needed. This cross-sectional study aimed to describe and analyze barriers to HIV testing as reported by Swedish patients newly diagnosed with HIV infection. N = 285 patients completed the 18-item Barriers to HIV Testing Scale - Karolinska Version. Descriptive analysis and logistic regressions were performed to assess the prevalence of barriers and to identify predictors for the different investigated barriers. Barriers to testing were reported by 60%. Approximately 67% of patients originating from Sweden, 50% from Sub-Saharan Africa and 75% from Eastern European/East Asian countries reported barriers. Patients who were younger and patients who self-initiated HIV testing, had greater odds of reporting a barrier than older individuals and those who were offered a test through screening or by a healthcare professional. To counteract barriers that still exist on an individual level, healthcare-initiated HIV testing could be offered more broadly and information about risks for transmission and effectiveness of HIV treatment still needs to be disseminated among both people born in Sweden and different migrant groups.
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| 18. |
- Gomez-Olive, Francesc Xavier, et al.
(författare)
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Prevalence of HIV among those 15 and older in rural South Africa
- 2013
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Ingår i: AIDS Care. - : Taylor & Francis. - 0954-0121 .- 1360-0451. ; 25:9, s. 1122-1128
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Tidskriftsartikel (refereegranskat)abstract
- A greater knowledge of the burden of HIV in rural areas of Southern Africa is needed, especially among older adults. We conducted a cross-sectional biomarker survey in the rural South African Agincourt Health and Socio-demographic Surveillance site in 2010-2011 and estimated HIV prevalence and risk factors. Using an age-sex stratified random sample of ages 15+, a total of 5037 (65.7%) of a possible 7662 individuals were located and 4362 (86.6%) consented to HIV testing. HIV prevalence was high (19.4%) and characterized by a large gender gap (10.6% for men and 23.9% for women). Rates peaked at 45.3% among men and 46.1% among women - both at ages 35-39. Compared with a similar study in the rural KwaZulu-Natal Province, South Africa, peak prevalence occurred at later ages, and HIV prevalence was higher among older adults - with rates above 15% for men and 10% for women through to age 70. High prevalence continues to characterize Southern Africa, and recent evidence confirms that older adults cannot be excluded from policy considerations. The high prevalence among older adults suggests likely HIV infection at older ages. Prevention activities need to expand to older adults to reduce new infections. Treatment will be complicated by increased risk of noncommunicable diseases and by increasing numbers of older people living with HIV.
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| 19. |
- Gusdal, Annelie K, 1963-, et al.
(författare)
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Peer counselors' role in supporting patients' adherence to ART in Ethiopia and Uganda
- 2011
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Ingår i: AIDS Care. - : Informa UK Limited. - 0954-0121 .- 1360-0451. ; 23:6, s. 657-662
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Tidskriftsartikel (refereegranskat)abstract
- Our aim was to explore peer counselors' work and their role in supporting patients' adherence to antiretroviral treatment (ART) in resource-limited settings in Ethiopia and Uganda. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Two main categories with related subcategories emerged from the analysis. The first main category, peer counselors as facilitators of adherence, describes how peer counselors played an important role by acting as role models, raising awareness, and being visible in the community. They were also recognized for being close to the patients while acting as a bridge to the health system. They provided patients with an opportunity to individually talk to someone who was also living with HIV, who had a positive and life-affirming attitude about their situation, and were willing to share personal stories of hope when educating and counseling their patients. The second main category, benefits and challenges of peer counseling, deals with how peer counselors found reward in helping others while at the same time acknowledging their limitations and need of support and remuneration. Their role and function were not clearly defined within the health system and they received negligible financial and organizational support. While peer counseling is acknowledged as an essential vehicle for treatment success in ART support in sub-Saharan Africa, a formal recognition and regulation of their role should be defined. The issue of strategies for disclosure to support adherence, while avoiding or reducing stigma, also requires specific attention. We argue that the development and implementation of support to peer counselors are crucial in existing and future ART programs, but more research is needed to further explore factors that are important to sustain and strengthen the work of peer counselors.
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| 20. |
- Gusdal, Annelie K, 1963-, et al.
(författare)
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Voices on adherence to ART in Ethiopia and Uganda : a matter of choice or simply not an option?
- 2009
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Ingår i: AIDS Care. - : Informa UK Limited. - 0954-0121 .- 1360-0451. ; 21:11, s. 1381-1387
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Tidskriftsartikel (refereegranskat)abstract
- This paper explores HIV patients' adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system level perspective. Two main themes emerged from the content analysis: "Patients' competing costs and systems' resource constraints'' and "Patients' trust in ART and quality of the patient-provider encounters.'' The first theme refers to how patients' adherence was challenged by difficulties in supporting themselves and their families, paying for transportation, for drug refill and follow-up as well as paying for registration fees, opportunistic infection treatment, and expensive referrals to other hospitals. The second theme describes factors that influenced patients' capacity to adhere: personal responsibility in treatment, trust in the effects of antiretroviral drugs, and trust in the quality of counseling. To grant patients a fair choice to successfully adhere to ART, transport costs to ART facilities need to be reduced. This implies providing patients with drugs for longer periods of time and arranging for better laboratory services, thus not necessitating frequent revisits. Services ought to be brought closer to patients and peripheral, community-based healthworkers used for drug distribution. There is a need for training providers and peer counselors, in communication skills and adherence counseling.
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| 21. |
- Hardon, A P, et al.
(författare)
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Hunger, waiting time and transport costs : time to confront challenges to ART adherence in Africa
- 2007
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Ingår i: AIDS Care. - : Informa UK Limited. - 0954-0121 .- 1360-0451. ; 19:5, s. 658-665
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Tidskriftsartikel (refereegranskat)abstract
- Adherence levels in Africa have been found to be better than those in the US. However around one out of four ART users fail to achieve optimal adherence, risking drug resistance and negative treatment outcomes. A high demand for 2nd line treatments (currently ten times more expensive than 1st line ART) undermines the sustainability of African ART programs. There is an urgent need to identify context-specific constraints to adherence and implement interventions to address them. We used rapid appraisals (involving mainly qualitative methods) to find out why and when people do not adhere to ART in Uganda, Tanzania and Botswana. Multidisciplinary teams of researchers and local health professionals conducted the studies, involving a total of 54 semi-structured interviews with health workers, 73 semi-structured interviews with ARTusers and other key informants, 34 focus group discussions, and 218 exit interviews with ART users. All the facilities studied in Botswana, Tanzania and Uganda provide ARVs free of charge, but ART users report other related costs (e.g. transport expenditures, registration and user fees at the private health facilities, and lost wages due to long waiting times) as main obstacles to optimal adherence. Side effects and hunger in the initial treatment phase are an added concern. We further found that ART users find it hard to take their drugs when they are among people to whom they have not disclosed their HIV status, such as co-workers and friends. The research teams recommend that (i) health care workers inform patients better about adverse effects; (ii) ART programmes provide transport and food support to patients who are too poor to pay; (iii) recurrent costs to users be reduced by providing three-months, rather than the one-month refills once optimal adherence levels have been achieved; and (iv) pharmacists play an important role in this follow-up care.
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| 22. |
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| 23. |
- Herder, Tobias, et al.
(författare)
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Navigating between rules and reality : a qualitative study of HIV positive MSM’s experiences of communication at HIV clinics in Sweden about the rules of conduct and infectiousness
- 2019
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Ingår i: AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV. - : Informa UK Limited. - 0954-0121. ; 31:10, s. 1304-1310
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Tidskriftsartikel (refereegranskat)abstract
- The rules of conduct given to people living with HIV in Sweden in accordance with the Swedish Communicable Diseases Act stipulate disclosure obligation to sexual partners and mandatory condom use. Since 2013, treating physicians have the possibility to exempt patients from this disclosure obligation when no considerable risk of transmission is present. This study explored experiences of communication with clinical staff at HIV clinics regarding rules of conduct and infectiousness among men who have sex with men (MSM) living with HIV in Sweden. In-depth interviews were carried out with 10 MSM living with HIV in Sweden. Study participants all reported unmeasurable viral loads. Data were analyzed using qualitative content analysis. Five categories and one theme, “Navigating between rules and reality”, were identified. We found that MSM living with HIV had good relationships with clinical staff at HIV clinics. Inconsistencies emerged regarding how they experienced receiving information about the rules of conduct and infectiousness. The findings indicate that lack of sound routines regarding how information and rules of conduct are communicated negatively affects MSM living with HIV and poses potential risks for the individual. The participants’ expressed trust in staff at HIV clinics can provide a good basis for improved communication.
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| 24. |
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| 25. |
- Houle, Brian, et al.
(författare)
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Sexual behavior and HIV risk across the life course in rural South Africa : trends and comparisons
- 2018
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Ingår i: AIDS Care. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 0954-0121 .- 1360-0451. ; 30:11, s. 1435-1443
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Tidskriftsartikel (refereegranskat)abstract
- There is limited information about sexual behavior among older Africans, which is problematic given high HIV rates among older adults. We use a population-based survey among people aged 15-80+ to examine the prevalence of sexual risk and protective behaviors in the context of a severe HIV epidemic. We focus on variation across the life course, gender and HIV serostatus to compare the similarities and differences of young, middle aged, and older adults. Younger adults continue to be at risk of HIV, with potential partners being more likely to have been diagnosed with an STI and more likely to have HIV, partner change is high, and condom use is low. Middle aged and older adults engage in sexual behavior that makes them vulnerable at older ages, including extramarital sex, low condom use, and cross-generational sex with people in age groups with the highest rates of HIV. We find insignificant differences between HIV positive and negative adults' reports of recent sexual activity. This study provides new information on sexual behavior and HIV risk across the life course in rural South Africa to inform HIV prevention and treatment programing.
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